As Psychiatric Wards Close, Patients Languish In Emergency Rooms

HealthOne is a Colorado hospital chain that is opening a psychiatric ward to take pressure off its hospitals' emergency rooms, including the one on the billboard.

Eric Whitney/CPR

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Originally published on May 31, 2012 5:45 am

Last fall, Kathy Partridge got a phone call from a local emergency room, telling her that her daughter, Jessie Glasscock, was there — and was OK.

Glasscock had gone missing overnight. She was away at college, and had a history of manic episodes. Police had found her in a Dumpster and brought her to the ER for her own safety. It was a huge relief for her mother. But she was completely surprised by what happened next.

"I went down to this emergency room and just found her by herself, basically locked in a closet," says Partridge.

The "closet" was actually an exam room, but Partridge says it was small and windowless, and the only furniture was a stainless steel bed. Her daughter waited there in nothing but a hospital gown, without treatment or a decent meal, for 24 hours.

Partridge was shocked to learn there was no place for her daughter to get treatment. "There was not a single psychiatric bed to release her in in the entire state of Colorado," she says.

The hospital eventually admitted Glasscock, but long waits like hers are all too common at hospitals nationwide. A study published this month in the Annals of Emergency Medicine by Anthony Weiss with Partners Healthcare in Massachusetts found psychiatric patients in hospital emergency departments waited an average of 11.5 hours before being treated or released.

That bothers Weiss. "It's very difficult to see patients waiting in the emergency room for, in some cases, really days," he says. "The fact that is, in many ways, their first introduction to mental health care is, in my mind, very, very devastating."

Weiss says there's a bottom line reason: Many hospitals don't even have psychiatric wards anymore. "The reimbursement for mental health care within the country is among the lowest across the different disease states," he says, "and so it's not, in some cases, economically viable to support these types of units."

One hospital chain is going against the trend. Denver's HealthOne hospital chain is opening a new psychiatric ward with 40 beds. It'll be one of the first Colorado has seen in years.

It isn't that HealthOne wants more psychiatric patients. It wants to compete for the shortest emergency room waiting times in Denver. Dr. George Bussey, HealthOne's chief medical officer, says psychiatric patients with no place to go can really slow things down.

"ER wait times are often a function of how many people are in your waiting room, and how many available beds you have," says Bussey. "And if you have, for example, a 30-bed emergency department, but you have five patients who aren't being moved out of beds, you've effectively turned yourself into a 25-bed emergency department, at which point you begin to get the backup."

ERs can bring hospitals a lot of business. HealthOne might lose money on its new psychiatric unit, but it stands to recoup its losses if it can provide speedier service in the ER. The chain says the new ward's main purpose is to provide better care for all of its patients and fill a gap in local health care.

Kathy Partridge is encouraged. But she recognizes that one new psychiatric ward isn't going to cure Colorado's lack of access to mental health treatment. Her daughter is back on her feet now, but her ER experience motivated Partridge to help start a committee at her church that looks for ways the health care system can be more welcoming to people who need psychiatric help.

This story is part of a project with Colorado Public Radio, NPR and Kaiser Health News.

A new study out this month finds an alarming trend at the nation's hospitals. The article in the May issue of the Annals of Emergency Medicine says people who show up at emergency rooms with psychiatric problems are often stuck there for hours, even days, waiting for a bed. For some time, hospitals have seen little financial incentive to maintain a lot of beds for psychiatric patients. But as Colorado Public Radio's Eric Whitney reports, that could be changing.

ERIC WHITNEY, BYLINE: Last fall, Kathy Partridge got a phone call from a local emergency room, telling her her daughter, Jessie Glasscock, was there, and was OK. It was a huge relief. Glasscock, away at college, has a history of manic episodes and had gone missing overnight. Police had found her in a dumpster, and brought her to the ER for her own safety. But Partridge didn't anticipate what happened next.

KATHY PARTRIDGE: It sort of seemed like well, they'll stabilize her, help her get back on her meds; and she'll pick up her pieces. Instead, I went down to this emergency room and just found her by herself - basically, locked in a closet.

WHITNEY: The closet was actually an exam room, but Partridge says it was really small, windowless, and the only furniture was a stainless steel bed. Glasscock waited there in nothing but a hospital gown, without treatment or a decent meal, for 24 hours.

PARTRIDGE: It was at that point that we learned that there was no place for her to go other than to be in that examination room; that there was not a single psychiatric bed to release her in, in the entire state of Colorado.

WHITNEY: The hospital eventually admitted Glasscock, but long waits like hers are all too common at hospitals nationwide. A study by Dr. Anthony Weiss, with the Partners Healthcare System in Massachusetts, found psychiatric patients in its hospitals waited an average of 11 and a half hours before being treated or released.

DR. ANTHONY WEISS: It's very difficult to see patients waiting in the emergency room for - in some cases, you know, really, days. The fact that this is, in many ways, their first introduction to mental health care is, in my mind - you know, very, very devastating.

WEISS: The reimbursement for mental health care, you know, within the country is amongst the lowest across different disease states. And so it's not, in some cases, economically viable to support these types of units.

WHITNEY: But fierce competition is driving Denver's HealthONE hospital chain to open a new psychiatric ward with 40 beds. It'll be one of the first Colorado has seen in years. Hospitals aren't competing to get more psychiatric patients, but to boast the lowest emergency room waiting times in Denver. Dr. George Bussey is HealthONE's medical director. He says psychiatric patients with no place to go can really slow things down.

DR. GEORGE BUSSEY: ER wait times are often a function of how many people are in your waiting room, and how many available beds you have. And if you have, for example, a 30-bed emergency department, but you have five patients who aren't being moved out of beds, you've effectively turned yourself into a 25-bed emergency department - at which point, you begin to get the back-up.

WHITNEY: ERs can bring hospitals a lot of money-making business. HealthONE might lose money on its new psychiatric unit, but stands to recoup its losses if it can provide speedier ER service. HealthONE says the new ward's main purpose is to provide better care for all its patients, and to fill a gap in local health care. Kathy Partridge, the mom whose daughter got stuck in an ER for 24 hours, says she doesn't really care why the new psychiatric ward is opening, just that it is.

PARTRIDGE: Oh, yeah. I'll go to the ribbon-cutting for that.

WHITNEY: Partridge recognizes that one new psychiatric ward isn't going to cure Colorado's lack of access to mental health treatment. Her daughter's back on her feet now, but her emergency room experience motivated Partridge to help start a committee at her church that looks for ways the health-care system can be more welcoming to people who need psychiatric help.

For NPR News, I'm Eric Whitney in Denver.

(SOUNDBITE OF MUSIC)

GREENE: And that story is part of a partnership with NPR, Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.